COVID-19 Contact Tracing Training Guidance and Resources

Last updated 5/8/2020

COVID-19 CONTACT TRACING TRAINING: GUIDANCE, RESOURCES, AND SAMPLE TRAINING PLAN Background: This document contains a sample training plan including training topics that may be helpful for state and local public health jurisdictions to consider when designing their own training plan for COVID-19 contact tracers. Each heading represents the learning objective for that section. Suggested training modalities/formats are provided, as well as information about sample existing trainings and resources. This document may be updated as new resources become available. For the purposes of this document, contact tracers are those who notify close contacts of COVID-19 patients of their exposures.

Overall Training Goal: After completing all training below, learners should be able to conduct contact tracing according to the established protocol.

Target Audience: Community health workers or volunteers with little or no experience conducting contact tracing.

Content describing non-CDC tools on this site is provided for informational purposes only and is not intended to indicate endorsement, actual or implied, of the tools. Additionally, information on this site is provided “as is,” for users to evaluate and make their own determination as to their effectiveness.

IDENTIFY STRATEGIES TO REDUCE SPREAD OF COVID-19

For this section, self-paced online training (e.g., curated reading list, videos, or eLearning course) is suggested. Inclusion of a post-test is strongly recommended.

• Background on COVID-19 o General o Epidemiology o Signs/symptoms o Update on current emergency response • Ways to prevent spread of COVID-19 o General precautions (e.g., social distancing) o Specific precautions for those potentially exposed or symptomatic ▪ Testing ▪ Contact tracing ▪ Quarantine ▪ Isolation ▪ Follow-up o Other ways to reduce spread IDENTIFY THE PRIMARY COMPONENTS OF COVID-19 CONTACT TRACING

A variety of modalities would be appropriate, including live webinar/teleconference, recorded webinar, or a self-paced eLearning course. Inclusion of a post-test is strongly recommended. Last updated 5/8/2020

• Introduction to US public health system and how contact tracing fits in o General • Relevant terminology o Public health jurisdiction’s contact tracing terminology o Terms that may be used in other jurisdictions (e.g., other states, federal) • Introduction to contract tracing o General o Define contact tracing o Describe basic steps of contract tracing: ▪ Test ▪ Investigation and elicitation ▪ Trace ▪ Quarantine or isolate ▪ Follow-up o Describe skills and qualities necessary for contact tracers ▪ Motivational interviewing skills ▪ Risk communication skills ▪ Cultural sensitivity ▪ Adaptations for contacts with communication impairments and non- English speakers LIST REQUIREMENTS FOR PROTECTING HEALTH INFORMATION

Self-paced online training (e.g., curated reading list, videos, or eLearning course) is suggested. Inclusion of a post-test is strongly recommended.

• Overview of health information privacy/security o Why it is important to protect health information o Potential consequences if data are not protected • Health information privacy and confidentiality o Oath of confidentiality, if applicable in the jurisdiction • Health information data security • Ethics of data collection during an outbreak DESCRIBE COVID-19 CONTACT TRACING PROTOCOL

Live training (whether through videoconference or a live course on a learning management system) or an eLearning course with knowledge checks is suggested so that learners can receive immediate feedback. Inclusion of a post-test – as well as an electronic guide describing jurisdiction-specific protocols – is strongly recommended.

• Describe in detail the actions and requirements associated with each step of the contact tracing process o Test o Investigation and elicitation Last updated 5/8/2020

o Trace o Quarantine or isolate o Follow-up • Learn what “a day in the life” of a contact tracer looks like by hearing from an experienced contact tracer • Question-and-answer session APPLY COVID-19 ONLINE KNOWLEDGE AND CONTACT TRACING PROTOCOL TO REALISTIC SCENARIOS

Live training (whether through videoconference or a live course on a learning management system) is suggested so that learners can receive real-time feedback and ask questions. Breakout sessions with smaller groups could be effective if multiple trainers or facilitators are available.

• Review contact tracing protocol • Apply contact tracing protocol to the following scenarios: o Recent contact with someone diagnosed with COVID-19 but no signs/symptoms o Recent contact with someone diagnosed with COVID-19 with signs/symptoms o Someone with signs and symptoms of COVID-19 with no history of ill contacts o Feedback from trainer(s)/facilitator(s) • Practice handling difficult calls o Role play with trainer/facilitator feedback IDENTIFY JURISDICTION-SPECIFIC CONTACT TRACING TOOLS AND PROTOCOLS

An electronic guide, self-paced asynchronous eLearning, or live training (whether through videoconference or a live course on a learning management system) describing jurisdiction- specific protocols and resources is suggested, along with opportunities to answer contact tracers’ questions via teleconference and an online frequently asked questions (FAQ) document that is regularly updated based on teleconference discussions and other feedback from the field.

• Receiving assignments • Documenting calls o Specifics of local processes and data collection • Working with non-English-speaking contacts • Working with contacts who have communication-impairments • Follow-up resources for contacts • Discussion of how contact tracers should share insights from the field – points of contact, regular check-in calls or webinars, online FAQ, etc. ANALYZE CONTACT TRACING ENCOUNTERS FOR CONTINUOUS QUALITY IMPROVEMENT

Virtual coaching and mentoring are suggested to provide opportunities for continuous quality improvement of contact tracing encounters. Last updated 5/8/2020

• Listening in on calls for quality • Using a rubric to documents contact tracers’ competencies and areas for improvement • Follow up discussion between supervisors and contact tracers on methods to improve the quality of the contact tracing experience TRAINING CATALOG BY LEARNING OBJECTIVE

IDENTIFY STRATEGIES TO REDUCE SPREAD OF COVID-19 Making Contact: A Training for COVID-19 Contact Tracers: The Basics of Coronavirus Disease 2019 (COVID-19) – Lesson 1 Topic areas: Background, signs/symptoms, general precautions, testing, quarantine, isolation, other ways to reduce spread • Register: https://learn.astho.org/p/ContactTracerexternal icon • Target audience: Contact tracers and new case investigators • Description: Contact tracers must understand the basics of coronavirus disease transmission in order to perform contact tracing and disease intervention activities effectively. Lesson one (The Basics of Coronavirus Disease 2019 (COVID-19)) will provide an overview of coronavirus disease 2019 (COVID-19), including its incubation and infectious period, symptoms, and how to prevent it. Please note, lessons must be completed in order from one to four. Lesson 1 learning objectives: 1. Describe what COVID-19 is 2. Describe how to prevent COVID-19 transmission 3. List symptoms of COVID-19 4. Define social distancing, quarantine, and isolation 5. Describe the incubation and infectious period

Emerging respiratory viruses, including COVID-19: methods for detection, prevention, response and control Topic area: Background • Register: https://www.train.org/main/course/1090092/external icon • Target audience: Public health professionals • Description: This course provides a general introduction to COVID-19. Learning objectives: 1. Describe the nature of emerging respiratory viruses, how to detect and assess an outbreak, strategies for preventing and controlling outbreaks due to novel respiratory viruses 2. Describe strategies that should be used to communicate risk and engage communities to detect, prevent and respond to the emergence of a novel respiratory virus

Last updated 5/8/2020

COVID-19 Public Health Strategy Basic Concepts – NDPHTN Topic areas: Epidemiology, Signs/Symptoms, General precautions, Testing, Quarantine, Isolation • Register: https://www.train.org/main/course/1090675/external icon • Target audience: Public health professionals • Description: Provides a basic background to the COVID-19 pandemic and describe the important steps to flatten the curve of COVID-19. Also provides an overview of crisis communication strategies and coordinating crisis response. Learning objectives: 1. Review coronavirus history 2. Review COVID-19 characteristics 3. Discuss 6 concepts to flatten the curve 4. Review the 10 social distancing recommendations 5. Review COVID-19 testing concepts 6. Discuss how cocooning protects high-risk individuals 7. Discuss key concepts of crisis communications in pandemics

Boots on the Ground Part 1: Foundational Epidemiology Topic area: Epidemiology • Register: https://www.train.org/main/course/1076135external icon • Target audience: Public health professionals and others without a background in epidemiology • Description: Provides basic principles of epidemiology and public health practice. Includes key terms used in epidemiologic and explains types of epidemiology research. Learning objectives: 1. Define epidemiology 2. Describe the key factors impacting the incidence and spread of disease, injury, or health outcome (i.e. agent, host, environment) 3. Describe basic key terms in epidemiology 4. Describe distribution of disease, injury, or health outcomes and understand bias, validity, and reliability in assessing public health problems 5. Identify bias, validity, and reliability 6. Identify research methods

COVID-19 Contact Investigation Training Topic area: Signs/symptoms Last updated 5/8/2020

• View: https://www.ncsddc.org/wp-content/uploads/2020/03/FINAL-COVID19-Contact-Training- 03112020.pdf pdf icon[PDF – 28 pages]external icon • Target audience: Case and contact investigators • Description: This course covers background information on COVID-19, tools that Washington State is using for case investigation, interviewing techniques, and resources for case and contact investigations. Learning objectives: 1. Discuss COVID-19 background 2. Discuss case investigation tools 3. Identify investigation interview techniques 4. Discuss types of contact follow-up 5. Identify COVID case and contact investigation resources

COVID-19 Real-Time Legal Response: Focus on Quarantine, Isolation, and Other Social Distancing Powers Topic area: General precautions • Register: https://www.train.org/cdctrain/course/1090658/external icon • Target audience: Public health professionals • Description: Following a brief series of COVID-19 legal updates, this real-time session will focus on an array of social distancing legal responses among federal, state, and local authorities, notably quarantine, isolation, school and other closures, and proposed “lockdowns.” After an initial presentation, your questions and comments will be addressed. Learning objectives: 1. Assess the legal bases for social distancing in response to COVID-19 2. Understand the core legal steps to engage quarantine and isolation 3. Consider varied powers of federal, state and local governments to institute school or other closures 4. Explore the constitutional limits of proposed lockdowns and other aggressive social distancing measures

COVID-19 Infection Prevention and Control in the Household (Microlearning) Topic area: General precautions • Register: https://www.train.org/main/course/1090934/external icon • Target audience: General public health staff • Description: This microlearning is designed to take 15 minutes. You will learn about instructions to give your patients who are taking care of a probable or confirmed case of COVID-19 in the household. Learning objectives: 1. Identify COVID-19 infection prevention and control measures for the household

Last updated 5/8/2020

CDC Coronavirus Disease 2019 (COVID-19) webpages Topic area: Epidemiology • Cases, Data, and Surveillance Topic area: Signs/symptoms • Symptoms of Coronavirus Topic area: Update on current emergency response • CDC in Action Topic areas: General precautions, Quarantine, Isolation • Prevent Getting Sick • Social Distancing, Quarantine, and Isolation Topic area: Testing • Testing for COVID-19

IDENTIFY THE PRIMARY COMPONENTS OF COVID-19 CONTACT TRACING Making Contact: A Training for COVID-19 Contact Tracers: The Basics of Contact Tracing – Lesson 2 Topic areas: Relevant terminology, define contact tracing, investigation and elicitation, trace, quarantine or isolate • Register: https://learn.astho.org/p/ContactTracerexternal icon • Target audience: Contact tracers • Description: The goal of lesson 2 (The Basics of Contact Tracing) is to provide an overview of the principles that will guide your work as a contact tracer. You will have the opportunity to learn basic definitions of contact tracing, gain an understanding of the steps involved, and become aware of the importance of confidentiality. Please note, lessons must be completed in order from one to four. Learning objectives: 1. Define person under investigation (PUI), contact, and contact tracing 2. Describe the objectives of contact tracing 3. List four fundamentals of contact tracing 4. Describe the importance of privacy protections 5. Identify the four main steps involved in the contact tracing process

Course: Making Contact: A Training for COVID-19 Contact Tracers: Effective Communication and Interviews – Lesson 3 Topic areas: Motivational interviewing skills, risk communication skills, cultural sensitivity, adaptations for contacts with communication impairments • Register: https://learn.astho.org/p/ContactTracerexternal icon • Target audience: Contact tracers and case investigators Last updated 5/8/2020

• Description: As a contact tracer, you will conduct interviews with people who may have been exposed to COVID-19. Depending on how your team is organized, you may also conduct interviews with persons under investigation (PUIs). Lesson 3 (Effective Communication and Interviews) will provide information on how to use effective communication techniques, prepare for and conduct an interview, and approach your interactions with cultural humility. Some of these terms may be new to you, and we’ll cover them as we move through the lesson. Please note, lessons must be completed in order from one to four. Learning objectives: 1. Name at least three communication techniques for effective interviewing 2. Explain the importance of showing cultural humility during case interviews 3. Describe how to prepare for an interview 4. Explain the four parts of an interview

Course: Making Contact: A Training for COVID-19 Contact Tracers: Case Monitoring and Resources – Lesson 4 Topic areas: Relevant terminology, follow-up • Register: https://learn.astho.org/p/ContactTracerexternal icon • Target audience: Contact tracers and case investigators • Description: Case investigators and contact tracers will follow-up and monitor cases (PUIs or their contacts) to ensure they are following appropriate isolation or quarantine instructions and to track the development of any potential COVID-19 symptoms. Lesson 4 (Case Monitoring and Resources) will provide information on the different types of case monitoring and the activities you might be involved in. Please note, lessons must be completed in order from one to four. Learning objectives: 1. Explain the difference between the two types of case monitoring 2. Describe potential follow-up activities that may be required during monitoring 3. Identify the types of resources and services that may be provided during the monitoring period. 4. Explain what it means to escalate or “refer up” a case that needs more help than you’re able to provide

Public Health 101 Series – Introduction to Public Health Topic area: Introduction to U.S. public health • Register: https://www.train.org/main/course/1059661/external icon • Target audience: Public health professionals and others without formal training in public health • Description: This course introduces learners to the mission of public health and key terms in the field. The course covers historical developments in public health, the roles of different stakeholders, public health’s core functions and essential services, determinants of health, and the Health Impact Pyramid. Learning objectives: Last updated 5/8/2020

1. Describe the purpose of public health 2. Define key terms used in public health 3. Identify prominent events in the history of public health 4. Recognize the core public health functions and essential services 5. Describe the role of different stakeholders in the field of public health 6. List determinants of health 7. Recognize how individual determinants of health affect population health

Emerging respiratory viruses, including COVID-19: methods for detection, prevention, response and control Topic area: Introduction to contact tracing • Register: https://www.train.org/main/course/1090092/external icon • Target audience: Public health professionals • Description: This course provides a general introduction to COVID-19. Learning objectives: 1. Describe the nature of emerging respiratory viruses, how to detect and assess an outbreak, strategies for preventing and controlling outbreaks due to novel respiratory viruses 2. Describe strategies that should be used to communicate risk and engage communities to detect, prevent and respond to the emergence of a novel respiratory virus

Covid-19 Epidemiology Grand Rounds Topic area: Introduction to contact tracing • Watch: https://www.facebook.com/ucsfepibiostat/videos/275226896828213/ • Target audience: Public health professionals • Description: Provides epidemiology updates on COVID-19, including impact of social distancing, health disparities, and comprehensive section on contact tracing (begins around 48:00). Learning objectives: Not available

An Introduction to Follow-up for Positive COVID-19 Cases and their close Contacts Topic area: Introduction to contact tracing • View: http://www.maventrainingsite.com/maven-help/pdf/LBOH%20Presentation%20COVID- 19%20Case%20Investigation%20Introductory%20Training%20Webinar_April8.pdf pdf icon[PDF – 49]external icon • Target audience: Public health professionals Last updated 5/8/2020

• Description: Provides an overview of COVID-19 transmission, testing, and common vocabulary. Describes contact tracing and interview tools. Learning objectives: Not available

General Contact Tracing Phone Calls Topic area: Define contact tracing • Register: https://www.train.org/main/course/1091008/external icon • Target audience: Volunteer callers for Michigan • Description: This training is a generalized contact tracing training to prepare volunteers for assisting and completing contact calls for persons who have been exposed to COVID19. The training briefly describes why contact training is important and what the process of contact training calls entails. Learning objectives: 1. Discuss what is contact tracing and why it is important 2. Discuss how to de-escalate difficult conversations 3. Discuss the script when calling someone exposed 4. Describe resources available to you to answer questions 5. Review how you will be receiving contacts, how you should be documenting and sharing the information you have gathered, to whom you should be reporting, and how often

Interviewing Unit 5: Cluster Interviews and Re-Interviews Topic area: Motivational interviewing skills • Register: https://www.train.org/main/course/1089364/external icon • Target audience: STD partner services providers • Description: Provides elements of cluster interviews for STD partner services providers. Includes the format of the interview and tips for providing risk reduction messages. Learning objectives: 1. Identify the reasons and conditions for conducting a Cluster Interview, including planning 2. Identify the elements of the Cluster Interview format and the difference in formats between a Cluster Interview and an Original Interview 3. Explain the process for choosing a Cluster candidate

COVID-19 Contact Investigation Training Topic area: Motivational interviewing skills Last updated 5/8/2020

Effective Interviewing for Contact Investigation: Self-Study Modules Topic area: Motivational interviewing skills • View: https://www.cdc.gov/tb/publications/guidestoolkits/interviewing/tbinterviewing_ssmodules.pdf pd f icon[PDF – 137 pages] • Target audience: TB interviewers • Description: This resource will offer guidance to both new and experienced TB interviewers about how to communicate clearly with patients under various circumstances. Consists of 4 modules, including an overview of the TB interview for contact investigations, basics of communication and patient education, cultural competency, and special interview circumstances. Learning objectives: 1. Define a TB interview 2. Formulate a TB interview strategy 3. Identify who requires a TB interview and for what reasons 4. Prioritize TB interviews based on various factors 5. Determine an infectious period for contact identification 6. Conduct a TB interview in a logical and productive manner 7. Conduct a re-interview asking the appropriate follow-up questions 8. Explain why patient education is important in the TB interview process 9. Define communication 10. Identify verbal and nonverbal patient cues and their meanings 11. Use closed, open-ended, and focused questions to gather descriptive, yet targeted information 12. Utilize the techniques of reflection, paraphrasing, and summarizing to affect the course of the interview 13. Address and overcome communication barriers Last updated 5/8/2020

14. Select, and communicate through, an appropriate interpreter 15. Apply effective communication concepts to patient education 16. Describe the concepts of culture and cultural competency 17. Identify various factors that contribute to an individual’s culture 18. Understand why cultural competency is essential in TB interviewing 19. Assess the communication process based on a patient’s verbal and nonverbal cues 20. Limit the barriers of language, dialect, lifestyle, and belief differences during an interview 21. Describe how TB interviews may vary depending on the patient’s life circumstances 22. Decide when to use, how to choose, and how to interview a proxy 23. Conduct a source case interview by selecting an appropriate interviewee and eliciting appropriate contact and exposure setting information 24. Conduct interviews in outbreak circumstances 25. Understand social network analysis and the role the interviewer plays

Introduction to Telephone Interviewing for DIS Topic area: Motivational interviewing skills • Watch: https://www.train.org/main/course/1090632external icon • Target audience: STD partner services providers • Description: This module will introduce partner services providers (i.e., DIS) to the basic principles and best practices for conducting telephone interviews. It covers professionalism, confidentiality and cultural competency. Learners also learn how to prepare for and conduct a telephone interview. Learning objectives: 1. Demonstrate confidence when planning and conducting telephone interviews 2. Understand principles and best practices for conducting telephone interviews 3. Improve communication skills and maximize interviewing effectiveness

COVID-19 Public Health Strategy Basic Concepts – NDPHTN Topic area: Risk communication skills • Register: https://www.train.org/main/course/1090675/external iconexternal icon • Target audience: Public health professionals • Description: Provides a basic background to the COVID-19 pandemic and describe the important steps to flatten the curve of COVID-19. Also provides an overview of crisis communication strategies and coordinating crisis response. Learning objectives: 1. Review coronavirus history Last updated 5/8/2020

2. Review COVID-19 characteristics 3. Discuss 6 concepts to flatten the curve 4. Review the 10 social distancing recommendations 5. Review COVID-19 testing concepts 6. Discuss how cocooning protects high risk individuals 7. Discuss key concepts of crisis communications in pandemics

CERC Overview for COVID-19 Topic area: Risk communication skills • Watch: https://emergency.cdc.gov/cerc/training/webinar_20200406.asp • Target audience: Public health professionals • Description: Provides an overview of crisis and emergency risk communication (CERC) principles and their application to COVID-19 messages. Learning objectives: 1. Define the six crisis and emergency risk communication (CERC) principles 2. Describe the lifecycle of CERC and how communication works at each phase of a crisis 3. Describe how emergency risk communication is different from regular communication 4. Describe the psychology of a crisis 5. Describe the process for gathering audience feedback 6. Describe how to tailor messages to target audiences 7. Develop a crisis communication plan 8. List best practices of a spokesperson 9. Explain best practices for engaging stakeholders through communication during an emergency

Communication Skills Topic area: Risk communication skills • Register: https://www.train.org/main/course/1089357/external icon • Target audience: STD partner services providers • Description: Provides learners with an understanding of the basic communication skills necessary for partner services providers, and to give them opportunities to practice those communication skills. This module also focuses on various problem solving techniques, and the importance of maintaining an assertive stance. Learning objectives: 1. Describe factors associated with good communication 2. Identify barriers to communication Last updated 5/8/2020

3. Define assertive, non-assertive, and aggressive communication and explain the distinctions between them

Disaster Health Core Curriculum: Competency 4: Communication Topic area: Risk communication skills • Watch: https://emergency.cdc.gov/cerc/training/webinar_20200406.asp • Target audience: Public health professionals • Description: Provides relevant, actionable guidance on applied principles and practices of crisis risk communication in public health emergencies and disasters. Learning objectives: 1. Explain the operational relevance of the following concepts in the context of public health crisis risk communication: risk perception, mental noise, trust determination, and negative dominance 2. Explain the relevance of cultural competency in the context of public health emergency risk communication 3. Identify strategies to communicate in a culturally competent fashion in public health emergencies and disaster events 4. Identify authoritative sources for information gathering in a public health crisis and disasters that can inform effective emergency risk communication during and after these events 5. Demonstrate the features and utility of a message map as a tool for public health emergency risk communication

Health Literacy for Public Health Professionals Topic area: Cultural sensitivity • Register: https://www.train.org/main/course/1078759/external icon • Target audience: Public health professionals • Description: The purpose of this web-based training program is to educate health professionals about public health literacy and their role in providing health information and services and promoting public health literacy. The course uses a 508-compliant template, knowledge checks, scenario-based interactions, video clips, and a post-test to engage learners. The course includes an evaluation, glossary, and resource list. Learning objectives: 1. Define public health literacy 2. List factors that influence public health literacy 3. Identify who is affected by public health literacy 4. Identify consequences of limited public health literacy 5. Determine who the stakeholders in public health literacy are Last updated 5/8/2020

6. Recognize the role of public health literacy in meeting core public health services 7. Apply lessons learned to improve public health literacy

COVID-19 Case and Contact Investigations Training for Tribes Topic area: Cultural sensitivity • Watch: https://register.gotowebinar.com/recording/9127662154523742734external icon • View slides: https://secureservercdn.net/50.62.172.232/tvl.3bf.myftpupload.com/wp- content/uploads/2020/03/Slides-Case-and-Contact-Investigations-Training-for-Tribes-03-27-2020.pdf pdf icon[PDF – 38 pages]external icon • Target audience: Native American tribes • Description: This course provides information for tribes to help them determine whether they will conduct case and contact investigations for COVID-19 or defer to Washington State. Additionally, the course provides training for tribal staff to conduct case and contact investigations. Learning objectives: 1. Describe why case and contact investigation is important for Tribes 2. Discuss COVID-19 background 3. Identify investigation interview techniques 4. Discuss case investigation tools 5. Discuss public health recommendations for contacts 6. Discuss types of contact follow-up 7. Identify COVID case and contact investigation resources

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